More teens are killing themselves, the Centers for Disease Control and Prevention (CDC) reported in March. A huge 17 percent of high school students had seriously considered suicide, and 8 percent had made an attempt in the previous 12 months. Fifteen- to 19-year-olds are the most common age group who show up in hospital emergency rooms after suicide attempts or other self-inflicted injuries.
How can we stop the trend? It’s often hard to predict who is in danger. Depression and a family history of suicide make suicide attempts more likely — but so do poor decision-making skills. Younger teens who attempt suicide may not have shown clear signs of depression, and they also may not seem especially impulsive.
When young people die by suicide, the only obvious risk factor may be the presence of a loaded gun in the home, notes David Brent, a psychiatrist at the University of Pittsburgh and an advocate of stronger gun-control laws. Restrictive gun laws have cut suicide death rates in Brazil, Canada, Australia, New Zealand, the United Kingdom, and U.S. states. Responsible parents who own guns can help by using trigger-locks and storing ammunition separately. Mothers sometimes don’t even know about a gun kept by Dad. The time between the decision to commit suicide and the action may be short — from 5 minutes to a day — so policies that make it harder to find that gun or bottle of pills can buy critical moments. According to research interviewing people who survived suicide attempts, many say they spoke to friends, family, and partners during the decisive interval.
If your teen is taking a breakup hard, do your best to keep booze out of reach. Any personal blow and alcohol can be a lethal combination, studies show. Also keep an eye on teens who can’t sleep; insomnia is tied to moodiness and suicidal thinking. Migraines or daily headaches are linked to suicidal thoughts as well. After reviewing a range of treatments for teens who have attempted suicide, Brent and colleagues concluded that the most successful get parents more involved, and help kids find new ways to feel happy. They suggest programs to promote quality sleep and sobriety.
Teens who get too little sleep, focus on electronic gadget activity, and don’t exercise — or about 29 percent of the teens in one huge sample from across Europe — may be in more trouble than you’d guess. If that sounds like your daughter, she’s in good company.
In a study published in 2014, researchers looked at data scoring 2,395 European high-school students on a wide range of measures, including heavy drinking, illegal drug use, heavy smoking, and truancy. About 13 percent scored high on all the risky-behavior measures; of this group, more than 10 percent had attempted suicide. The sedentary sleep-deprived Internet-users, who the researchers considered an “invisible risk group,” were almost as likely to have suicidal thoughts, and nearly 6 percent of them had made a suicide attempt. Among teens who didn’t score high on any of the danger signs, 1.7 percent had attempted suicide.
Is there any good news here? Well, a suicide attempt doesn’t mean your kid is doomed. About 15 to 30 percent of teens who make one attempt try again within a year, which means the majority don’t.
However, they may still be thinking about it, and clinicians haven’t had reliable ways to foresee the moment a chronically suicidal person may act, notes Igor Galynker, MD, PhD, at Mount Sinai Beth Israel Hospital in New York. Patients can be good at fooling even expert observers. One result is that people often die in the first week after discharge from a psychiatric unit.
Hunting for tell-tale clues, Galynker and his team have identified an intense pre-suicidal state of “frantic hopelessness.” As one patient put it, “Imagine you have been left behind in a department store after hours. The lights are going out. You are trying to escape, you are running from door to door, but all the doors are locked.” In this state people feel trapped and overwhelmed by their own painful, repetitive thoughts — as if their heads could explode. They may also have unfamiliar physical sensations, often in the skin and all over the body.
Two questions to ask: “Do you feel trapped with no good options left? Are you overwhelmed by — or have you lost control of — negative thoughts filling your head?” Galynker found that patients — not necessarily young — who answer “Yes” emphatically to both questions had a higher risk of attempting suicide after discharge — and so do those who emphatically answer “No.” Discharging patients from psychiatric wards is clearly a tough job.
December 05, 2016
Christopher Nystuen, MD, MBA